Praxis
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A 26 year old women was seen at our outpatient clinic because of fever, dyspnea, chest pain and night sweats. An echocardiography revealed a moderate pericardial effusion. Therapy with a nonsteroidal anti-inflammatory drug was started, but the patient did not improve clinically. ⋯ Usual laboratory tests, serological tests and examination of pleural effusion were not conclusive. However, a tuberculin skin test was positive. The etiologic diagnosis of this pericarditis and pleuritis was obtained by thoracoscopic pleural biopsy, which yielded Mycobacterium tuberculosis.
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Based on case reports pathogenesis and treatment of the following diabetic emergencies were discussed: 1. The hyperosmolar non-ketotic coma without or with only modest ketosis occurring mainly in type II diabetics and the severe ketoacidosis with or without disturbed consciousness occurring mainly in type I diabetics are the two forms of severe metabolic decompensation of diabetes mellitus. 2. Severe hypoglycaemia may be caused by treatment with sulfonylureas and insulin. 3. ⋯ Under insulin treatment the following risk factors for severe hypoglycaemia need to be considered: metabolic control in the near normal range, intensified treatment with rapidly decreasing HbA1c-levels, impaired renal function, unawareness o hypoglycaemia. When the renal function is impaired, biguanide treatment is not indicated because of the risk of lactic acidosis. Most of the diabetic emergency situations are avoidable by proper education of the patients.
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Emergencies in oncologic patients are common and diverse. Almost every cancer patient will develop at least one emergency situation at the beginning or in the further course of his disease. ⋯ In this review detailed descriptions of spatial cord compression syndrome, superior vena cava obstruction as well as hypercalcemia are given. Finally problems due to cerebral metastases, pulmonary embolism, hyperviscosity and hyperuricemia are briefly summarized.
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The rationale and indication, but also the efficacy and limitation of lumbar epidural corticosteroid injection in patients suffering from acute lumbosacral radicular pain are explained. Epidural administration of corticosteroids with longterm effect and bupivacaine by a translumbar approach in patients suffering from acute low back pain and sciatica causes an immediate, persistent pain relief and a more prompt regression of nerve root compression compared to patients just treated by bed rest and analgesics. ⋯ The postulate of an application performed by an experienced anaesthesiologist is stressed. Advantages of this invasive form of therapy include reduction of addictive analgesic drugs, decreased time of absolute immobilisation, respectively strict bed rest, and of hospitalisation.